AU593581B2 - Surgical clip, applier, and method - Google Patents

Surgical clip, applier, and method Download PDF

Info

Publication number
AU593581B2
AU593581B2 AU63250/86A AU6325086A AU593581B2 AU 593581 B2 AU593581 B2 AU 593581B2 AU 63250/86 A AU63250/86 A AU 63250/86A AU 6325086 A AU6325086 A AU 6325086A AU 593581 B2 AU593581 B2 AU 593581B2
Authority
AU
Australia
Prior art keywords
tang
invention
bridge portion
degrees
clip
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
AU63250/86A
Other versions
AU6325086A (en
Inventor
Robert B. Cushman
Zhu Yuong Hua
Wolff Mayer Kirsch
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
University of New Mexico
Original Assignee
University of New Mexico
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority to US787101 priority Critical
Priority to US06/787,101 priority patent/US4733664A/en
Application filed by University of New Mexico filed Critical University of New Mexico
Publication of AU6325086A publication Critical patent/AU6325086A/en
Application granted granted Critical
Publication of AU593581B2 publication Critical patent/AU593581B2/en
Anticipated expiration legal-status Critical
Application status is Ceased legal-status Critical

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/10Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/08Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
    • A61B17/083Clips, e.g. resilient
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/30Surgical pincettes without pivotal connections
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1107Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis for blood vessels

Description

593581 This doculjcnlt cntains the amendments mnace u' Section 49 and is con-ect lu1 COMMONWEALTH OF AUSTRALIA 9 t Patents Act 1952 t e Name of Applicants: THE UNIVERSITY OF NEW MEXICO and ROBERT B. CUSHMAN Address of Applicants: Albuquerque, New Mexico 87131, (i ~United States of America.

Box 435, Cedar Crest, New Mexico 87008, United States of America Actual Inventors: Wolff Mayer Kirsch, Yuong Hua Zhu, Robert B. Cushman COMPLETE SPECIFICATION FOR THE INVENTION ENT.TLED:- "SURGICAL CLIP, APPLIER, AND METHOD" The following statement is a full description of the invention including the best method of performing it known to us:- -1- 1 111\ 11- 414£ tt 4r C itt it it t C t CC tr BACKGROUND OF THE INVENTION THIS INVENTION relates generally to the field of surgery, and more particularly to the field of vascular micro-surgery.

In various surgical procedures, it is necessary to unite or reunite very small blood vessels, nerves and the like. The procedure of joining blood vessels is known as vascular anastomosis. Particularly in neurosurgical procedures and in the reattachment of severed body members, the number of anastomoses required can be very numerous, and accordingly, it is advantageous and frequently necessary to perform each such connection quickly yet properly.

A conventional end-to-end anastomosis is 15 illustrated in Fig. 1, which shows a pair of vessels 1 and 2, each held by a respective clamp 3 or 4 while it is sutured around its circumference. The vessel ends are first approximated by inward traction on the two vascular clamps. The vessels may then be preliminarily interconnected by placing sutures at two, three or four spaced locations around the circumference of the vessel note the threads 5 and 6 in tension whereafter the suturing 7 is completed with a needle 8. Various suturing techniques are known, all of which are designed 25 to: provide a leak-proof connection; provide adequate tensile strength; avoid unnecessary restriction of the vessel; avoid unnecessary tearing and other trauma to the vessel; and promote -2tc 4 a r 5 1

I

4 t 44 1 Sel

C

4 S *r 4 S S

I

rapid and thorough healing. Some of these objectives become increasingly difficult to satisfy as smaller and smaller anastomoses are carried out; furthermore, the danger of accidentally catching the rear oR distal wall of a vessel with the needle as the proximal wall is being sutured increases with diminishing vessel size.

With all vascular suturing techniques, thrombosis or clotting tends to occur at the points of needle penetration. While this clotting would not usually be sufficient to occlude larger vessels, in smaller veins and arteries a significant constriction or complete occlusion of the vessel can result from clotting. The problem has been summarized thus: "It is apparent to us that the damage to vascular endothelium 15 caused by the microvascular needle perforation is considerable. The amount of subsequent platelet aggregation and clot formation can be extensive, and these platelets are known to release vasoactive substances that can alter. vessel diameter. This could diminish blood flow through a 1- to 2-mm vascular anastomosis expected to give immediate increased flow to an underperfused region of the brain." D. Pagnanelli et al, The Cutting Edge Microsurgical Needle, Journal of Nerurosurgery, volume 59, ni. 3, pages 510-512 (Sept.

25 1983).

In addition to the physiological damage done by suturing, it is also significant that suturing, particularly of small vessels, is a very tedious time- -3-

C

consuming procedure which can preoccupy and fatigue a surgeon over the course of a long procedure. A more rapid way of performing micro-vascular anastomoses could free the surgeon for other tasks, and could shorten surgical procedures as well. The need for a workable, rapid, non-suturing technique for microsurgery is obvious.

Various non-suture devices and techniques for performing anastomoses are known, particularly for intestinal and colorectal anastomeses, for which various stapling apparatus and methods have been known for some years. Known stapling techniques, however, require penetration of the organ wall, and if applied to vascular anastomoses, the problems of clotting and the r** like, as described above, could be expected to arise.

4 t I For vascular anastomosis, various other non-suture Smechanical clamps have been suggested. Such clamps t frequently include a permanent or sacrificial ferrule or the like and means for clamping the vessel against the 20 ferrule so that penetration of the vessel wall is avoided. However, clamps of this type have not gained 4 ;widespread acceptance.

In view of the foregoing, this invention has c r C been made with a view to substantially increasing the CC C 25 speed of microvascular anastomoses and other procedures while avoiding the clotting problems caused by conventional suturing procedures. Another object is to reduce the material costs and duration of ia 4 a r *4 r *r microsurgical procedures.

A further object of the invention is to provide a permanently implantable surgical clip for use in place of microvascular suturing. Yet another object is to provide the surgeon with a clip that can be easily held and applied during vascular anastomoses.

This invention relates generally to a surgical procedure such as an anastomosis wherein a pair of tissues is approximated, then partially everted, and then joined by placing the arms of a surgical clip over the adjoined tissues and crimping the arms about the tissues in such a way as to hold the tissues together without penetrating them.

The invention is also directed to a vascular 15 surgical clip comprising a plastically deformable4 bedy portion, a tang for deforming the4 bedy, and a neck connecting the tang to theheby, wherein the neck is designed to break upon application of a predetermined tensile force to the tan, and the4bed being designed to deform upon application to the tang of less than said predetermined tensile force.

In a further aspect, the invention is directed to a tool for applying the subject clip. In its broadest sense, the tool includes means for gripping and 24 applying tension to the tang, and means for simultaneously pushing against shoulders on the clip body. The tool enables the surgeon to perform the subject method by using the tool first to manipulate 9 t (r

I!:

trl i 5 S. i- se r" ~gCLL:r~~~ :i -i C C t r V Ct C 4£ the clip into position over opposed tissues. Then by squeezing or otherwise manipulating the tool, he deforms the clip so as to capture the tissues between the clip's arms and thereby hold the tissues permanently together.

BRIEF DESCRIPTION OF THE DRAWINGS The invention is illustrated by the following description of a preferred embodiment and by the drawings, wherein: Fig. 1 illustrates a prior art suturing method described above; Fig. 2 is an oblique view of the inventive clip in its original, undeformed condition; Fig. 3 is a view similar to Fig. 2 showing the clip in a partially deformed condition; Fig. 4 shows the clip in its fully deformed condition; Fig. 5 is an elevational view of the inventive clip applier; Fig. 6 is an enlarged view of a portion of Fig 5. and Fig. 7 is a view similar to Fig. 1, illustrating the inventive procedure.

DESCRIPTION OF THE PREFERRED EMBODIMENT As shown in Fig. 2, a surgical clip embodying the invention is formed of a unitary piece of biologically acceptable, plastically deformable material such as a noble metal gold, silver, platinum, etc.). While metal clips are presently 44 C I 4 rrr 25 c i ~dl ii? 1 r preferred, it is contemplated that other materials such as suitable polymer plastics may be used. Whatever the material, it must be sufficiently ductile or plastically deformable so that when the clip is crimped there is minimal spring-back. Otherwise, possibly injurious overcrimping, to compensate for the spring-back, would be required.

Structurally, the clip includes a pair of inwardly curved arms 10 and 11 interconnected by a parallel in one direction from the- iging3eci.

The arms terminate at tips 15 and 16 which are rounded to prevent injury to the subject tissue in accordance *'er «with an object of this invention. The bridge portion 12 S; 15 includes a pair of shoulders 17, 18 for engaging the o |applier tool described below. The centre of the bridge c C is integrally connected to a tang 19 preferably having l t e an enlarged head 20. The connection point is a neck 21 of reduced cross-section designed to break when a Vt t 9, 20 predetermined tension is applied to the tang by the tool. The size of the neck is such that its breaking ,.t 1 r strength ("predetermined tensile force" in the claims below) is greater than the tension required to deform, e' r 25 by bending, the bridge portion of the clip.

The size of the clip will naturally vary F .according to the application, and we do not intend to limit the scope of this invention to any particular size clip. However, merely as an example, for the S-7- L anastomosis of a l-mm vessel, an appropriate size clip has an overall height on the order of .030 inches and an overall thickness on the order of .006 inches. For this size clip, the radius of curvature of the tip of each arm is approximately .0005 iLiches.

To deform the clip, tension is applied to the tang 19 by a tool such as that described below, while the shoulders are supported by stationary jaw faces on the tool (Fig. The relationship of the jaw faces and the clip shoulders is preferably such that the points of engagement are substantially spaced; i.e., such points are initially remote from the neck. Because of this geometry, application of a tension T to the tang 1 produces a bending moment M TX/2 at the centre of the 15 bridge, where X equals the distance from the tang axis C, to either contact point, as shown in Fig. 3. The neck is sufficiently strong that a bending moment large enough to deform the bridge portion can be produced (Fig. In designing the applier and the clip, the v 20 abutting surfaces of the clip shoulders and the jaw faces are so designed that once a desired degree of C« r bending deformation has occurred, the contact points move much closer to the neck, whereafter even substantially increased tang tension does not generate a bending moment sufficient to cause bridge deformation, but rather ultimately fractures the neck 21 (Fig. A particular advantage of this feature is that the amount of bridge deformation is accurately determined by the -8- 0 1

V"

4f *c I 'I (CS I (C t I *I Ii .4 (4 11( clip/tool geometry, and is thus independent of the surgeon's manipulating force. As a result, the deformation from clip to clip and from surgeon to surgeon is highly reproducible for a given clip/tool combination. Furthermore, one of skill in the art will appreciate how simple changes in jaw face geometry or clip shoulder shape could be made to produce desired changes in the degree of clip deformation.

Figs. 5 and 6 show a clip applier constructed in accordance with this invention. The applier includes means for gripping a clip tang, preferably in the form of a single movable jaw 50 having a slot 52 sized to receive the tang, which slot has an enlarged pocket or recess 54 sized to receive the tang's head. The jaw is 15 supported in a body 56 that terminates at a forward end defined by stationary jaw faces 58, 60 astride the slot and designed to engage the shoulders 17, 18 on the clip. In the embodiment shown, the jaw faces 58, 60 are

A

planar and have between them an obtuse angleA of approximately 120 degrees, which is less than the angle B of approximately 150 degrees between the clip shoulders. Comparing Figs. 3 and 4, one will note the inward shift in contact point location which results from this geometry as the clip deforms.

The jaw is retracted away from the abutment faces by any of several mechanisms, most preferably a cam-actuated device responsive to squeezing pressure from the surgeon's hand. In this embodiment, shown in ;i i i:' -9 i: (i 7 "i r r 4g 4 t 41 1 S.

4 $S

I

4 4, I tA C .!4 4 4 C 4' 4 Fig 5, the applier body 56 includes a pair of flexible leaves 62,64 interconnected at both ends and movable toward each other when the tool is squeezed by the surgeon. Each leaf has an inner surface from which a cam 66 protrudes, the cam having an actuating surface 68 oblique to its direction of movement. As viewed in Fig. 5, the cams are symmetrical in profile, and overlap so as jointly to engage a common cam follower 70. This follower is connected to the jaw 50 as shown. When the leaves are squeezed together, the cam surfaces approach one another, causing the movable jaw 50 to retreat with respect to the stationary jaw faces 58,60. When a clip is in place within the tool, this action causes deformation as previously described. In Fig. 5 the arcuate shape of the cam faces 68 is noteworthy. This shape makes the ratio of squeezing force to retracting force an increasing function, giving better feel in situations where it is desired intentionally to limit clip deformation to less than that .dictated by the 20 shapes of the abutting surfaces.

While the retracting mechanism is preferably purely mechanical for reasons of simplicity, other mechanisms, such as a fluid-driven piston, or an electrically actuated solenoid, are also contemplated.

25 In any event, what is required is a safe, reliable mechanism for retracting the jaw with respect to the body, responsive to a simple manipulation by the surgeon.

I

4: 10 8! i

I

r

I

i T a It will be appreciated that the proper geometry for the clip depends on the shape of the applier's jaw and abutment surfaces, and vice-versa.

Therefore, these two items must be co-operatively designed.

Fig.7 illustrates an end-to-end microvascular anastomosis employing the clip and applier described above. In this procedure, a pair of tissues to be joined are first drawn together in apposition (approximated) by suitable means. The edges of the tissues should be partially everted, that is, pursed or flanged outwardly approximately 90 degrees from the axial direction, so that a clip can be placed over the i tissue edges, with the arms of the clip astride the i 15 point of apposition. Care must be taken not to allow the vessel to cuff back over on itself, since the joint ultimately produced would be weaker than the flanged I f configuration. Once the clip has been positioned properly with respect to the subject tissues,, crimping Ia, 20 is effected simply by squeezing together the leaves of S the tool. This causes permanent deformation of the microclip bridge section 12, whereafter the clip arms 10,11 retain the tissues in apposition without 'puncturing them. This procedure is repeated at as many 25 points as are needed to join the subject tissues securely. The clips, being biologically inert, ordinarily may be left in place permanently. However, in the event that the clip must be removed, a suitable -11g4~

QI.

.4 C

~C

r~ I t *gaI.

9* 99~9 9 9 I I

CIII

II IC e c C tool may be used to spread the arms 10 and 11.

The clip and applier tool described above provide a sutureless means for the apposition of tissue which is substantially faster than conventional suturing methods, particularly in microvascular anastomosis and which avoids the clotting problem caused by needle perforations. In testing on femoral arteries in rats, short and long term patency and remarkably little damage to'the vascular endothelium have been observed.

An advantage of 'the inventive clips over sutures is the predictability of results. In contrast to hand-made micro-suturing needles, the masproduced microclips are uniform, producing more uniform results.

15 An additional advantage is that the speed of application reduces the time blood supply is interrupted, enhancing prospects for vessel patency.

Another advantage is that on any tissues joined in accordance with this invention, the clips are 20 physically independent of one another. Thus, although they securely hold the tissues together at individual points, the clips can move with respect to one another.

As a result, their spacing can increase as tissues grow.

This makes the present invention particularly attractive for performing anastomoses in children, whose vessels must later expand. Permanent sutures (Fig. 1) must of course be removed if they are not to interfere with vessel growth.

-12-

A

It should be understood that the foregoing description and drawings describe and illustrate but one embodiment of the invention, whose scope should be measured by the following claims.

a.

4* a a9* a 9* 1 a.: It a. a: a a a a.

a ja. a 9a 0 9 .0 0 0 0* *0*4 4* 0 at.: a t a t a at a I 13

I

Claims (24)

1. A surgical clip, comprising a plastically deformable bridge portion, a tang for deforming said bridge portion, and a neck connecting said tang to said bridge portion, said neck being designed to break upon application of a predetermined tensile force to said tang, said bridge portion being deformable by application to the tang of less than said predetermined tensile force.
2. A surgical clip comprising a plastically deformable bridge portion, a pair of spaced arms extending generally parallel in one direction from opposite ends of said bridge portion, $of, a tang extending from said bridge portion in a direction opposite that of said arms, for deforming said t bridge portion so as to bring said arms together around opposed tissues, Sa neck connecting said tang to said bridge portion, I t said neck being breakable upon application of a predetermined tensile force to said tang, said bridge portion being deformable by application to the tang of less than said predetermined tensile force.
3. The invention of claim 2, further comprising an enlarged head on said tang to facilitate gripping thereof by an applier tool.
4. The invention of claim 2, wherein each of said arms is arcuate and has a concave surface facing the other arm SA X l whereby tissue may be retained between the arms when the bridge is deformed.
The invention of claim 4 where said arms terminate at distal tips which are sufficiently rounded to avoid puncturing tissue captured between said arms when said bridge is deformed.
6. The invention of claim 2, further comprising a pair of spaced shoulders on said bridge portion, one on either side of said neck, for supporting said clip as tension is applied to said tang, to create a bending moment in said bridge for deforming the same.
7. The invention of claim 6, wherein said shoulders are generally flat so as to limit deformation of said when tension is applied to said tang.
8. The invention of claim 7, wherein said shoulders lie .It. t at an obtuse angle in the range of 120 degrees with respect to one another. S.
9. The invention of claim 7, wherein said shoulders lie S' t at an obtuse angle of about 120 degrees with respect to one another.
A tool for deforming a surgical clip as claimed in any one of the preceding claims comprising I* means for gripping and applying tension to said t iI S'1 tang, and means for simultaneously engaging said surgical clip at said bridge portion.
11. The invention of claim 10, wherein said engaging Al I means comprises a pair of spaced stationary jaw faces adapted to engage shoulder portion on said bridge portion.
12. The invention of claim 11 wherein said jaw faces are generally flat, and lie at an obtuse angle in the range of 120 degrees to 180 degrees with respect to one another.
13. The invention of claim 12, wherein said obtuse angle is about 150 degrees. r 11 41 I Ic I cc t Ct C C Cl
14. The invention of claim 11, wherein said gripping and tensioning means comprises a jaw moveable with respect to said stationary ja. faces, and means for retracting said movable jaw.
The invention of claim 14, wherein said retracting means comprises a cam and a cam follower, said cam being connected to manipulable means on the applier, and said follower being connected to said movable jaw.
16. The invention of claim 15, wherein said manipulable means comprises at least one flexible leaf affixed to said body, a portion of said leaf being deflectable by finger pressure with respect to said body, said cam being mounted on said movable portion.
17. The invention of claim 16, comprising two of said leaves, each being integrally connected, at both its ends, to said body whereby the central portions of the leaves can be moved toward one another by squeezing the applier.
18. The invention of claim 15, wherein said cam includes an actuating surface lying oblique to the axis of movement of said movable jaw, and said follower is engaged by said -T RAZ/ 1Lcrr II~ 4I *s 4 I I 4r r- 4 i 1 *r 4 61 1 actuating surface.
19. The invention of claim 18, wherein sa.'d actuating surface is arcuate.
The invention of claim 18, wherein said follower is a roller.
21. The combination of: a surgical clip comprising a plastically deformable bridge portion, a pair of spaced arms extending generally parallel in one direction from opposite ends of said bridge portion, a tang extending from said bridge portion in a direction opposite that of said arms, for deforming said bridge portion so as to bring said arms together around opposed tissues, a neck connecting said tang to said bridge portion, said neck being breakable upon application of a predetermined tensile force to said tang, said bridge portion being deformable by application to the tang of less than said predetermined tensile force, a pair of shoulders on said bridge portion, one on either side of said neck, said shoulders being defined by bearing surfaces having an obtuse angle B between them, and a tool for deforming said clip, comprising means for gripping and applying tension to said tang, and including a pair of spaced stationary jaw faces adapted to engage said clip shoulders respectively, wherein said jaw faces are generally flat, and lie at an obtuse angle A with 17 64*$ 6 I Ic I iI I' I 1 i r- ~aaj 1'' r respect to one another, wherein said angles are defined by the relationships 120 degrees <A <180 degrees, B <180 degrees, and A<B.
22. The invention of claim 21, wherein angle B is about degrees greater than angle A.
23. A method of performing a surgical anastomosis comprising steps of aligning a pair of blood vessels, everting the tissue edges by about 90 degrees so that the vessel intimal surfaces face one another, opposing said surfaces, and closing a plurality of clips as claimed in any one of claims I to 9 around said edges at spaced locations so as permanently to hold said vessels together, while allowing for circumferential expansion thereof.
24. A method of joining biological tissues comprising steps of aligning edges of said tissues, everting said edges by about 90 degrees so that the tissue surface face one another, and Sclosing a plurality of clips as claimed in any one of claims 1 to 9 around said edges at spaced locations so as Sto permanently to hold said tissues together, while allowing for growth thereof. DATED this day of 3 S C. 1989. THE UNIVERSITY OF NEW MEXICO and ROBERT B. CUSHMAN By Their Patent Attorneys G R CULLEN CO 1 T O i 0,
AU63250/86A 1983-12-01 1986-09-30 Surgical clip, applier, and method Ceased AU593581B2 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
US787101 1985-10-15
US06/787,101 US4733664A (en) 1983-12-01 1985-10-15 Surgical clip, applier, and method

Publications (2)

Publication Number Publication Date
AU6325086A AU6325086A (en) 1987-04-16
AU593581B2 true AU593581B2 (en) 1990-02-15

Family

ID=25140421

Family Applications (1)

Application Number Title Priority Date Filing Date
AU63250/86A Ceased AU593581B2 (en) 1983-12-01 1986-09-30 Surgical clip, applier, and method

Country Status (11)

Country Link
US (1) US4733664A (en)
JP (2) JP2642098B2 (en)
AU (1) AU593581B2 (en)
BR (1) BR8605015A (en)
DE (1) DE3633124C2 (en)
FR (1) FR2588467B1 (en)
GB (1) GB2181356B (en)
IN (1) IN165360B (en)
IT (1) IT1218121B (en)
SE (2) SE467723B (en)
ZA (1) ZA8607462B (en)

Families Citing this family (95)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4935026A (en) * 1987-12-09 1990-06-19 Mcfadden Joseph T Articulatable, rotatable, surgical clamping device
AU4191989A (en) 1988-08-24 1990-03-23 Marvin J. Slepian Biodegradable polymeric endoluminal sealing
US5634946A (en) * 1988-08-24 1997-06-03 Focal, Inc. Polymeric endoluminal paving process
US5779718A (en) * 1992-10-09 1998-07-14 United States Surgical Corporation Method of anastomosing a vessel using a surgical clip applier
CA2133687C (en) * 1992-10-09 2007-03-27 David T. Green Surgical clip applier
CA2107635C (en) * 1992-10-09 1999-08-17 David T. Green Surgical clip applier
US5868761A (en) * 1992-10-09 1999-02-09 United States Surgical Corporation Surgical clip applier
FR2702647B1 (en) * 1993-03-18 1995-05-05 Baudet Jacques The process of micro-anastomosis of blood vessels and automatic clamp for its implementation Óoeuvre.
EP0781114B1 (en) * 1994-09-16 2005-05-25 Ethicon Endo-Surgery, Inc. Devices for defining and marking tissue
US6024748A (en) * 1996-07-23 2000-02-15 United States Surgical Corporation Singleshot anastomosis instrument with detachable loading unit and method
US7169158B2 (en) * 1996-07-23 2007-01-30 Tyco Healthcare Group Lp Anastomosis instrument and method for performing same
US6440146B2 (en) * 1996-07-23 2002-08-27 United States Surgical Corporation Anastomosis instrument and method
US7223273B2 (en) * 1996-07-23 2007-05-29 Tyco Healthcare Group Lp Anastomosis instrument and method for performing same
US5707380A (en) * 1996-07-23 1998-01-13 United States Surgical Corporation Anastomosis instrument and method
US20020019642A1 (en) * 1996-07-23 2002-02-14 Keith Milliman Anastomosis instrument and method for performing same
US5902310A (en) * 1996-08-12 1999-05-11 Ethicon Endo-Surgery, Inc. Apparatus and method for marking tissue
US6030410A (en) * 1998-05-18 2000-02-29 Zurbruegg; Heinz Robert Sternal closure technique and kit for performing same
US6261302B1 (en) 1998-06-26 2001-07-17 Ethicon Endo-Surgery, Inc. Applier for implantable surgical marker
US5941890A (en) * 1998-06-26 1999-08-24 Ethicon Endo-Surgery, Inc. Implantable surgical marker
DE19859950C2 (en) * 1998-08-11 2003-08-21 S & T Ag Neuhausen Am Rheinfal A surgical stapler and apparatus for their application
US6206913B1 (en) * 1998-08-12 2001-03-27 Vascular Innovations, Inc. Method and system for attaching a graft to a blood vessel
US6220248B1 (en) 1998-10-21 2001-04-24 Ethicon Endo-Surgery, Inc. Method for implanting a biopsy marker
US6083237A (en) * 1998-10-23 2000-07-04 Ethico Endo-Surgery, Inc. Biopsy instrument with tissue penetrating spiral
US6210419B1 (en) 1998-12-18 2001-04-03 Aesculap Ag & Co. Kg Surgical clip
US6235031B1 (en) 2000-02-04 2001-05-22 Encore Medical Corporation Intramedullary fracture fixation device
US6425903B1 (en) 2000-05-09 2002-07-30 James W. Voegele Implantable surgical marker
US7264625B1 (en) 2000-06-19 2007-09-04 Buncke Harry J Surgical clip applier with remote operation
ZA200006432B (en) 2000-09-08 2000-12-08 Christy Cummins Surgical micro-stapling instrument.
JP4472217B2 (en) 2000-10-16 2010-06-02 オリンパス株式会社 Clip apparatus of living tissue
US7094245B2 (en) * 2001-10-05 2006-08-22 Scimed Life Systems, Inc. Device and method for through the scope endoscopic hemostatic clipping
US7195142B2 (en) * 2003-05-30 2007-03-27 Tyco Healthcare Group Lp End-to-end anastomosis instrument and method for performing same
US6769594B2 (en) * 2002-05-31 2004-08-03 Tyco Healthcare Group, Lp End-to-end anastomosis instrument and method for performing same
US20040010274A1 (en) * 2002-07-10 2004-01-15 Manzo Scott E. Anastomosis instrument and method for performing same
US8900253B2 (en) 2003-03-11 2014-12-02 Covidien Lp Clip applying apparatus with angled jaw
US20040193213A1 (en) * 2003-03-11 2004-09-30 Ernest Aranyi Clip applying apparatus with curved jaws, and clip
US8394114B2 (en) * 2003-09-26 2013-03-12 Medtronic, Inc. Surgical connection apparatus and methods
US7494461B2 (en) * 2003-09-30 2009-02-24 Boston Scientific Scimed, Inc. Through the scope tension member release clip
EP3443915A3 (en) * 2003-09-30 2019-05-15 Boston Scientific Scimed, Inc. Through the scope tension member release clip
WO2005046489A1 (en) * 2003-11-07 2005-05-26 Scimed Life Systems, Inc. Endoscopic hemoscopic clipping apparatus
DE102004030391A1 (en) 2004-06-23 2006-01-26 Somatex Medical Technologies Gmbh marker
ES2650172T3 (en) 2004-09-23 2018-01-17 Covidien Lp Apparatus fastener applier and ligating clip
US7819886B2 (en) * 2004-10-08 2010-10-26 Tyco Healthcare Group Lp Endoscopic surgical clip applier
US8409222B2 (en) 2004-10-08 2013-04-02 Covidien Lp Endoscopic surgical clip applier
EP2957235B1 (en) * 2004-10-08 2019-02-20 Covidien LP An endoscopic surgical clip applier
WO2006042110A2 (en) * 2004-10-08 2006-04-20 Tyco Healthcare Group, Lp Apparatus for applying surgical clips
US8080021B2 (en) * 2005-01-11 2011-12-20 Boston Scientific Scimed, Inc. Multiple clip deployment magazine
US20070089433A1 (en) * 2005-10-20 2007-04-26 Smurfit-Stone Container Enterprises, Inc. Methods and systems for monitoring a shelf life of a product stored within a container
US7738401B2 (en) * 2005-10-20 2010-06-15 At&T Intellectual Property I, L.P. System and method for overlaying a hierarchical network design on a full mesh network
USD625009S1 (en) 2006-03-24 2010-10-05 Tyco Healthcare Group Lp Surgical clip applier
USD629101S1 (en) 2006-03-24 2010-12-14 Tyco Healthcare Group Lp Surgical clip applier
CA2605135C (en) 2006-10-17 2014-12-30 Tyco Healthcare Group Lp Apparatus for applying surgical clips
AU2008230841B2 (en) 2007-03-26 2013-09-12 Covidien Lp Endoscopic surgical clip applier
CN102327136B (en) 2007-04-11 2014-04-23 柯惠Lp公司 Surgical clip applier
US8465502B2 (en) 2008-08-25 2013-06-18 Covidien Lp Surgical clip applier and method of assembly
US8056565B2 (en) 2008-08-25 2011-11-15 Tyco Healthcare Group Lp Surgical clip applier and method of assembly
US8267944B2 (en) 2008-08-29 2012-09-18 Tyco Healthcare Group Lp Endoscopic surgical clip applier with lock out
US8409223B2 (en) 2008-08-29 2013-04-02 Covidien Lp Endoscopic surgical clip applier with clip retention
US9358015B2 (en) 2008-08-29 2016-06-07 Covidien Lp Endoscopic surgical clip applier with wedge plate
US8585717B2 (en) 2008-08-29 2013-11-19 Covidien Lp Single stroke endoscopic surgical clip applier
FR2938422A1 (en) 2008-11-17 2010-05-21 Pierre Sarradon vascular anastomosis clips and method of application
US8052741B2 (en) * 2009-03-23 2011-11-08 Medtronic Vascular, Inc. Branch vessel prosthesis with a roll-up sealing assembly
US20110082480A1 (en) * 2009-10-01 2011-04-07 Tyco Healthcare Group Lp Wound closure device including pivotable claws
US20110082473A1 (en) * 2009-10-07 2011-04-07 Tyco Healthcare Group Lp Wound closure device including releasable barbs
US8734469B2 (en) 2009-10-13 2014-05-27 Covidien Lp Suture clip applier
US8435252B2 (en) * 2009-11-11 2013-05-07 Covidien Lp Wound closure device
US9186136B2 (en) 2009-12-09 2015-11-17 Covidien Lp Surgical clip applier
US8545486B2 (en) * 2009-12-15 2013-10-01 Covidien Lp Surgical clip applier
US8545519B2 (en) 2009-12-22 2013-10-01 Cook Medical Technologies Llc Medical devices with detachable pivotable jaws
WO2012051188A2 (en) 2010-10-11 2012-04-19 Cook Medical Technologies Llc Medical devices with detachable pivotable jaws
EP3441015A1 (en) * 2009-12-22 2019-02-13 Cook Medical Technologies, LLC Medical devices with detachable pivotable jaws
US10010336B2 (en) 2009-12-22 2018-07-03 Cook Medical Technologies, Inc. Medical devices with detachable pivotable jaws
WO2012051191A2 (en) 2010-10-11 2012-04-19 Cook Medical Technologies Llc Medical devices with detachable pivotable jaws
CN108742757A (en) 2010-10-11 2018-11-06 库克医学技术有限责任公司 Medical devices with detachable pivotable jaws
US8403945B2 (en) * 2010-02-25 2013-03-26 Covidien Lp Articulating endoscopic surgical clip applier
US9044240B2 (en) * 2010-03-10 2015-06-02 Boston Scientific Scimed, Inc. Hemostasis clip
US8968337B2 (en) 2010-07-28 2015-03-03 Covidien Lp Articulating clip applier
US8403946B2 (en) 2010-07-28 2013-03-26 Covidien Lp Articulating clip applier cartridge
US8906042B2 (en) 2010-07-29 2014-12-09 Covidien Lp Wound closure device including mesh barrier
EP2651316B1 (en) 2010-12-15 2016-07-06 Cook Medical Technologies LLC Medical devices with detachable pivotable jaws
US9011464B2 (en) 2010-11-02 2015-04-21 Covidien Lp Self-centering clip and jaw
US9186153B2 (en) 2011-01-31 2015-11-17 Covidien Lp Locking cam driver and jaw assembly for clip applier
DE102011001706A1 (en) 2011-03-31 2012-10-04 Aesculap Ag A surgical clip applier
US9775623B2 (en) 2011-04-29 2017-10-03 Covidien Lp Surgical clip applier including clip relief feature
US9364239B2 (en) 2011-12-19 2016-06-14 Covidien Lp Jaw closure mechanism for a surgical clip applier
US9364216B2 (en) 2011-12-29 2016-06-14 Covidien Lp Surgical clip applier with integrated clip counter
US9017404B2 (en) 2012-01-23 2015-04-28 Lloyd P. Champagne Devices and methods for tendon repair
US9408610B2 (en) 2012-05-04 2016-08-09 Covidien Lp Surgical clip applier with dissector
US9532787B2 (en) 2012-05-31 2017-01-03 Covidien Lp Endoscopic clip applier
US9480515B2 (en) 2012-07-12 2016-11-01 Exsomed International IP, LLC Metacarpal bone stabilization device
US9113892B2 (en) 2013-01-08 2015-08-25 Covidien Lp Surgical clip applier
US9750500B2 (en) 2013-01-18 2017-09-05 Covidien Lp Surgical clip applier
WO2015050896A1 (en) * 2013-10-02 2015-04-09 Exsomed Holding Company Llc Nerve coupler
US9622523B2 (en) 2014-01-06 2017-04-18 Exsomed International IP, LLC Ergonomic work gloves
US10245091B2 (en) 2015-12-30 2019-04-02 Exsomed Holding Company, Llc Dip fusion spike screw
US10194923B2 (en) 2016-05-10 2019-02-05 Exsomed International IP, LLC Tool for percutaneous joint cartilage destruction and preparation for joint fusion

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3446212A (en) * 1965-07-19 1969-05-27 New Research & Dev Lab Inc Hemostatic clip and applicator therefor
US3774438A (en) * 1969-07-29 1973-11-27 Ici Ltd Applicator for surgical clips
US3827277A (en) * 1969-07-29 1974-08-06 Ici Ltd Applicator for surgical clips

Family Cites Families (29)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US984629A (en) * 1910-04-25 1911-02-21 Carroll W Brinkley Staple.
US2501567A (en) * 1944-05-19 1950-03-21 Huck Mfg Co Rivet
US2635501A (en) * 1951-03-30 1953-04-21 Gen Motors Corp Hollow rivet
US2662524A (en) * 1952-08-07 1953-12-15 Archibald P Hudgins Tenacular needle
US3232089A (en) * 1961-05-25 1966-02-01 Rene G Le Vaux Anastomotic clip and elements
US3192821A (en) * 1962-11-19 1965-07-06 Olympic Screw & Rivet Corp Blind rivet having a grooved and deformable locking boss
US3361133A (en) * 1965-07-22 1968-01-02 Canadian Patents Dev Vacuum artery clamp
US3604425A (en) * 1969-04-11 1971-09-14 New Research And Dev Lab Inc Hemostatic clip
US3807406A (en) * 1971-06-25 1974-04-30 Bio Medicus Inc Instrument surgical with suction device
DE2308846C3 (en) * 1972-02-24 1979-11-29 Pierre Perisse
GB1427397A (en) * 1973-04-24 1976-03-10 Ici Ltd Forceps
US3916909A (en) * 1973-08-01 1975-11-04 Bio Medicus Inc Suction surgical instrument of the forceps type
JPS5320957Y2 (en) * 1973-11-14 1978-06-01
JPS552966Y2 (en) * 1974-02-08 1980-01-24
US3980086A (en) * 1974-02-28 1976-09-14 Bio-Medicus, Inc. Fluid conveying surgical instrument
US4049002A (en) * 1975-07-18 1977-09-20 Bio-Medicus, Inc. Fluid conveying surgical instrument
US4096864A (en) * 1975-03-26 1978-06-27 Bio-Medicus, Inc. Fluid carrying surgical instrument of the forceps type
US4004835A (en) * 1975-09-15 1977-01-25 Taylor William T Overshot
SU1088712A1 (en) * 1979-11-14 1984-04-30 Всесоюзный научно-исследовательский и испытательный институт медицинской техники Apparatus for circular suture of blood vessels
US4396139A (en) * 1980-02-15 1983-08-02 Technalytics, Inc. Surgical stapling system, apparatus and staple
US4324248A (en) * 1980-05-30 1982-04-13 Metatech Corporation Microsurgical clip
JPS6366053B2 (en) * 1980-07-15 1988-12-19 Citizen Watch Co Ltd
US4394864A (en) * 1981-04-15 1983-07-26 Jeffrey Sandhaus Apparatus and method for effecting occlusion of the vas deferens
US4397312A (en) * 1981-06-17 1983-08-09 Dittmar & Penn Corp. Clip applying forceps
US4453756A (en) * 1982-02-25 1984-06-12 Texaco Inc. Wireline fishing tool
AT378116B (en) * 1982-07-20 1985-06-25 Gleichner Franz tweezers
US4531522A (en) * 1983-06-20 1985-07-30 Ethicon, Inc. Two-piece tissue fastener with locking top and method for applying same
US4586503A (en) * 1983-12-01 1986-05-06 University Of New Mexico Surgical microclip
DE8516296U1 (en) * 1985-06-04 1985-08-08 Wenzler, Guenther, 7201 Balgheim, De

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3446212A (en) * 1965-07-19 1969-05-27 New Research & Dev Lab Inc Hemostatic clip and applicator therefor
US3774438A (en) * 1969-07-29 1973-11-27 Ici Ltd Applicator for surgical clips
US3827277A (en) * 1969-07-29 1974-08-06 Ici Ltd Applicator for surgical clips

Also Published As

Publication number Publication date
JPS63260545A (en) 1988-10-27
FR2588467B1 (en) 1989-12-29
JPH07213525A (en) 1995-08-15
IT1218121B (en) 1990-04-12
FR2588467A1 (en) 1987-04-17
IN165360B (en) 1989-09-23
SE9000183L (en) 1990-01-19
DE3633124A1 (en) 1987-04-23
SE467723B (en) 1992-09-07
GB2181356A (en) 1987-04-23
US4733664A (en) 1988-03-29
JP2599577B2 (en) 1997-04-09
IT8684144D0 (en) 1986-10-15
SE8604346L (en) 1987-04-16
GB2181356B (en) 1989-09-27
AU6325086A (en) 1987-04-16
JP2642098B2 (en) 1997-08-20
SE8604346D0 (en) 1986-10-14
SE9000183D0 (en) 1990-01-19
BR8605015A (en) 1987-07-14
ZA8607462B (en) 1987-08-26
DE3633124C2 (en) 1995-06-22
SE467722B (en) 1992-09-07
GB8623961D0 (en) 1986-11-12

Similar Documents

Publication Publication Date Title
US6626919B1 (en) Method and apparatus for attaching or locking an implant to an anatomic vessel or hollow organ wall
US6923820B1 (en) Surgical connector systems and methods of use
US5053047A (en) Suture devices particularly useful in endoscopic surgery and methods of suturing
US6565581B1 (en) Apparatus and method for performing an anastomosis
US5074874A (en) Suture devices particularly useful in endoscopic surgery
US5154189A (en) Method for repairing a torn meniscus
AU2003243219B2 (en) Anastomotic staple with fluid dispensing capillary
EP0687446B1 (en) Surgical incision members for endoscopic suturing apparatus
CA2210619C (en) Anastomosis instrument and method
EP0597260B1 (en) Needle having true I-beam cross-section
EP2067441B1 (en) Surgical staple
JP4028175B2 (en) Gastrointestinal compression clip
US6126677A (en) Suture fastener and instrument
US4981149A (en) Method for suturing with a bioabsorbable needle
US4932962A (en) Suture devices particularly useful in endoscopic surgery and methods of suturing
US5916224A (en) Tendon repair clip implant
CA1158126A (en) Purse stringer
US5626590A (en) Laparoscopic suturing technique and associated device
US6669707B1 (en) Method and apparatus for attaching or locking an implant to an anatomic vessel or hollow organ wall
US5972024A (en) Suture-staple apparatus and method
EP0594004B1 (en) Surgical clip applier
CN1173667C (en) Device for repairing of arteries
JP4204791B2 (en) Surgical knot pusher device
US4519392A (en) Hemostasing muscle clips for needleless surgery
US5766183A (en) Vascular hole closure

Legal Events

Date Code Title Description
MK14 Patent ceased section 143(a) (annual fees not paid) or expired